The way professionals conceptualise CD likely impacts the identity of children given the diagnosis, yet how psychiatrists conceptualise CD, and experience making the diagnosis, is under-researched. Interpretative Phenomenological Analysis explored how psychiatrists conceptualise CD and experience making the diagnosis. Semi-structured interviews captured participants’ lived experiences and associated meanings. Four superordinate themes emerged: ‘Parents and professionals are overwhelmed by their struggles with CD’; ‘What is CD? Uncertainty regarding the cause, but clarity that it is a severe problem’; ‘CD as a controversial construct’; and ‘Whose issue is it anyway? Battles with blame and responsibility’. The emerging problem-saturated narrative is discussed. Clinical implications include increased training, reflective practice and using a formulation-based approach.

The severity criterion used in DSM-5 for bulimia nervosa (BN) was investigated in 214 individuals referred for treatment at a regional eating disorders service in the UK. In addition to comparing eating disorder symptoms, impairment secondary to these symptoms was also assessed. According to guidance in DSM-5, 94 individuals were classified as mild (43.9%), 70 as moderate (32.7%), 32 as severe (15.0%), and 8 as extreme (3.7%) levels of BN severity. Due to small numbers in the latter two groups, it was necessary to combine these to form one 'severe/extreme' group. Analyses on these three groups suggested no group effect on demographic variables but differences were seen on measures of eating pathology, psychological distress, and psychosocial impairment between the mild group and other groups. Individuals in the moderate and severe/extreme groups scored comparably on most measures of pathology and impairment. The results are broadly consistent with past studies on community samples although together question the demarcation between moderate and more severe groups of individuals with BN.

People with mental disorder account for a disproportionately large amount of smokers, and the problem is greatest in inpatient settings. 'Stop smoking' services should be tailored to the needs of individual patient groups. It is important therefore to investigate factors relevant to different groups in order to inform future quit smoking interventions. We compared 50 patients and 50 staff in a secure mental health hospital on measures of smoking and smoking motives, nicotine dependence, craving, previous cessation attempts, motivation to quit and quit smoking-related self-efficacy. Patients were significantly more dependent on nicotine with higher levels of craving; were more likely to smoke to cope with stress, for something to do when bored, for enjoyment and pleasure; and reported significantly less readiness to quit smoking. Staff were more likely to cite health concerns as reasons for quitting. Future pre-intervention work with inpatients should focus on increasing their readiness to quit smoking. Once motivation is increased, interventions should include advice on reducing cravings, finding alternative methods for coping with stress and boredom and achieving enjoyment and pleasure from alternative sources.

Engagement in1-year's treatment was associated with significant reduction in risk behaviours and both staff-rated and self-rated outcome measures. Some significant questions remain about which elements of the programme are most effective but the results are encouraging.